Provider Demographics
NPI:1346663622
Name:ANGIE LEE, DMD, MS, PLLC
Entity Type:Organization
Organization Name:ANGIE LEE, DMD, MS, PLLC
Other - Org Name:ANGIE LEE PERIODONTICS & IMPLANT DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:970-999-4321
Mailing Address - Street 1:2445 WINDROW DR UNIT A206
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-6782
Mailing Address - Country:US
Mailing Address - Phone:970-999-4321
Mailing Address - Fax:
Practice Address - Street 1:1220 OAK PARK DR STE 2
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-7302
Practice Address - Country:US
Practice Address - Phone:970-999-4321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2019441223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty